Inadvertent Intrauterine Instillation of Trichloroacetic Acid During Sonohysterography

Trichloroacetic acid (TCAA) solution is used to treat vulvar condyloma and cervical intraepithelial neoplasia. Saline infusion sonohysterography (SIS) detects intrauterine pathology and fallopian tube patency in infertile patients. A 33-year-old Caucasian nulliparous fertility patient presented to the emergency department with extensive burns following accidental intrauterine instillation of TCAA during SIS with tubal perfusion. On presentation, the patient was hemodynamically stable. There was extensive erythema and tenderness in a spill/burn pattern on both thighs as well as the groin, perineum, and labia. Speculum exam revealed white, leathery mucosa with the absence of normal vaginal rugae. The abdominal exam was notable for generalized tenderness without guarding or rebound. Complete blood count (CBC), serum electrolytes, and CT scan were unremarkable. The patient was admitted for observation and pain management. She received serial abdominal exams, topical aquaphor, vaginal estrogen, and serial labs and pelvic imaging. The patient remained stable and was discharged on hospital day two. At three months, the patient reported improvement in pain and gradual skin healing. She resumed fertility treatment at a different fertility center, and a frozen embryo transfer resulted in a live birth. This case demonstrates severe vaginal and perineal injury after intrauterine instillation of TCAA. At three months, vaginal and external genitalia required ongoing burn care. Notably, endometrial recovery is evidenced by the delivery of a live birth after embryo transfer. The case underscores a preventable medical accident and highlights the regenerative ability of endometrial stem cells to respond to hormonal cues and restore endometrial receptivity after chemical trauma.